Lee, Ling Yi and Tan, Cheng Yin and Wong, Kum Thong and Goh, Khean Jin and Shahrizaila, Nortina (2023) Diagnostic yield of nerve biopsy in the evaluation of peripheral neuropathies. Journal of Clinical Neuroscience, 107. pp. 40-47. ISSN 0967-5868, DOI https://doi.org/10.1016/j.jocn.2022.11.017.
Full text not available from this repository.Abstract
Background: With progress made in neurogenetics and neuroinflammation, the indications and value of nerve biopsies in the diagnostic evaluation of peripheral neuropathies are less clear. In this study, we aimed to evaluate the diagnostic yield of nerve biopsies in patients with peripheral neuropathies. Methods: We performed a retrospective review of nerve biopsy reports from April 1998 to June 2021 of patients with peripheral neuropathies presenting to the Department of Pathology, University of Malaya Medical Centre, Kuala Lumpur, Malaysia. The diagnostic value of the biopsies was determined based on the criteria by Midroni and Bilbao as follows: contributive (essential and helpful), non-contributive and inadequate. Results: A total of 107 nerve biopsies were analysed. Sixty-four (60 %) were males and the mean age was 52 years, ranging from 13 to 86 years. Ninety-four (88 %) were sural nerve biopsies; and only one patient (1 %) each had superficial peroneal and superficial radial nerve biopsy. The indications for the procedure were vasculitis (34 %), peripheral neuropathy of unknown aetiology (34 %), amyloidosis (14 %) and chronic inflammatory demyelinating polyneuropathy (10 %). In 68 (63 %) biopsies, the diagnostic value was contributive. Of these, 28 (26 %) were essential and 40 (37 %) were helpful. In contrast, 35 (33 %) biopsies were non-contributive and 4 (4 %) were inadequate. In 66 % (71/107) of cases, the nerve biopsy did not reveal a definite pathological diagnosis. However, in the remainder, a diagnosis of vasculitis (18 %, 19/107), followed by amyloidosis (10 %, 11/107) could be determined. For 32/71 biopsies with undetermined pathological diagnosis, neuropathy remained cryptogenic in 22 % (7/32) upon follow up. Conclusions: With the exception of vasculitis and amyloidosis, there is limited value in performing nerve biopsies in the evaluation of patients with peripheral neuropathy. However, this should be interpreted with caution as the number of patients with a clinical diagnosis of vasculitis and amyloidosis were relatively larger than patients with other diagnosis. Refinement and careful selection of cases are required to increase the diagnostic yield of nerve biopsy.
| Item Type: | Article |
|---|---|
| Funders: | University of Malaya, Department of Medicine Research Grant DOMRSF-2021-01 |
| Uncontrolled Keywords: | Amyloidosis; Nerve biopsy; Peripheral neuropathy; Sural nerve; Vasculitic neuropathy; Vasculitis |
| Subjects: | R Medicine > RC Internal medicine > RC0321 Neuroscience. Biological psychiatry. Neuropsychiatry |
| Divisions: | Faculty of Medicine > Neurosurgery Department Faculty of Medicine > Pathology Department |
| Depositing User: | Ms Zaharah Ramly |
| Date Deposited: | 24 Nov 2023 08:08 |
| Last Modified: | 24 Nov 2023 08:08 |
| URI: | http://eprints.um.edu.my/id/eprint/39235 |
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